Supping with the Devil: Belief and the Imaginary World of Multiple Myeloma Therapies Invented by the Institute for Clinical and Economic Review

Langley, Paul C

doi:10.24926/iip.v12i3.4215

Cited by 2 publications

(1 citation statement)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is into this imaginary world of assumption-driven simulations that manufacturers are cast once ICER decides to make an example of their product. In all fairness, manufacturers are all too often on the back foot and there is nowhere to turn to challenge ICER from day one 7 . An example is seen in the Health Benefit Price Benchmark (HBPB).…”

Section: The Unreality Of Icer Beliefmentioning

confidence: 99%

A Critical Examination for the Pricing of Eculizumab and Efgartigimod in Myasthenia Gravis

Langley

2021

Innov Pharm

View full text Add to dashboard Cite

The recently released Institute for Clinical an Economic Review’s (ICER’s) final evidence report for eculizumab and efgartigimod in myasthenia gravis is one more example of a commitment to the invention of evidence to support pricing and formulary decisions. This is the ICER business model where the practitioners cling to a belief system that rejects the standards of normal science and, more spectacularly, a passionate belief in the mystical ratio properties of ordinal scales that denies the axioms of fundamental measurement. Without these beliefs ICER’s business model would collapse. This is pseudoscience: a collection of beliefs or practices mistakenly regarded as being based on scientific method. Unfortunately there are many who share ICER’s beliefs, including academic research centers and health decision makers who should know better; in this case the University of Illinois at Chicago, College of Pharmacy, Center for Pharmacoepidemiology and Pharmacoeconomic Research who, under contract to ICER developed the imaginary assumption driven simulation model to support invented claims for pricing and reimbursement for eculizumab and efgartigimod. Whether this shared belief is by accident, ignorance or design is an open question; the fact is that it is widely held to the detriment of patients where insurers and health system fall upon ICER pronouncements as support for pricing and denial of care; in particular the absurd Health Benefit Price Benchmark (HBPB). This HBPB amounts to a neo-eugenic application of a bankrupt methodology. The purpose of this commentary is to focus on two aspects of the ICER-Illinois invented evidence modeling: the first aspect, the downside of assumption driven simulation modeling, the potential creation of a multitude of competing models, the mathematically impossible quality adjusted life year (QALY) and the misguided attempt to deny the axioms of fundamental measurement in mapping ordinal EQ-5D-5L preferences from the ordinal Quantitative Myasthenic Gravis (QMG) score. The second aspect of this commentary is to propose rejecting the analytical dead end of imaginary simulation modeling by proposing standards that should be set for the creation and evaluation of value claims in health technology assessment, in particular need fulfillment quality of life (QoL), that meet the demarcation test to distinguish science from non-science (or pure bunk). The result is that the ICER pricing claims for eculizumab and efgartigimod in myasthenia gravis are nonsense and should be rejected out of hand. Not only should the respective manufacturers ignore them, but this message needs to be transmitted to health system decision makers before care is denied and patients harmed in myasthenia gravis.

show abstract

Section: The Unreality Of Icer Beliefmentioning

confidence: 99%

A Critical Examination for the Pricing of Eculizumab and Efgartigimod in Myasthenia Gravis

Langley

2021

Innov Pharm

View full text Add to dashboard Cite

show abstract

Abandoning Eugenics and the QALY

Langley

2021

Innov Pharm

Self Cite

View full text Add to dashboard Cite

Should decision making in health care, notably in respect of the allocation of resources between individuals and disease states, rest on notions of the burden of disease and denial of care as assessed by societal evaluations or on the extent to which the need of patients and caregivers is fulfilled. The prospect of the denial of health care, for those deemed ‘unworthy’ has a long history in the eugenics movement. Many have assumed that this ‘utilitarian aberration’ has long been discredited. Unfortunately, once the question of the allocation of limited health care resources is considered it reasserts itself; manifested in the creation of health state preferences and states worse than death, and application of the cost-per-QALY calculus driving claims for pricing and access. In the US, this focus on cost-per-QALY claims is most closely associated with the Institute for Clinical and Economic Review (ICER) with its regular clinical assessments and modelled imaginary simulations supporting recommendations which, in many if not most cases, give support to the denial of care. The purpose of this commentary is to point to the unfortunate similarities between ‘eugenic’ decision making and the application of thresholds in burden of illness cost-per-QALY exercises. If we are to finally rid ourselves of a ‘eugenic’ approach to health care resource allocation, then we must abandon preferences and the QALY calculus.

show abstract

Supping with the Devil: Belief and the Imaginary World of Multiple Myeloma Therapies Invented by the Institute for Clinical and Economic Review

Cited by 2 publications

References 13 publications

A Critical Examination for the Pricing of Eculizumab and Efgartigimod in Myasthenia Gravis

A Critical Examination for the Pricing of Eculizumab and Efgartigimod in Myasthenia Gravis

Abandoning Eugenics and the QALY

Contact Info

Product

Resources

About